The single portal percutaneous epiphysiodesis technique for treatment of leg length inequality stops growth as expected.

One technique for distal femur and proximal tibia epiphysiodesis to treat leg length inequality is a single-incision percutaneous technique using reamers and curettes. The purpose of this study is to demonstrate the efficacy and reliability of this technique by quantifying the growth arrest produced from this method. Patients who underwent distal femur and proximal tibia epiphysiodesis with a single-incision percutaneous technique were retrospectively reviewed. Using scanogram data, derivative formulas of both the multiplier and arithmetic methods were used to predict bone length after physeal arrest at maturity. Patients included had at least 2-year follow-up after surgery. Predicted bone lengths were then compared to actual bone lengths obtained via scanogram at final follow-up. A total of 46 patients were included in the study (27 males; 19 females). Average age at surgery was: males 14.5 years, females 12.4 years. Surgery was performed on 40 distal femurs and 25 proximal tibias. Postoperative femurs demonstrated an actual mean length of 44.75 cm. Predicted femur bone lengths utilizing the multiplier and arithmetic methods were 45.08 and 44.08 cm, respectively. Postoperative tibias demonstrated an actual mean length of 38.12 cm. Predicted tibia lengths utilizing the multiplier and arithmetic method were 38.30 and 38.02 cm. No significance was found between actual and predicted bone lengths for both tibias and femurs. This study demonstrates that a single-incision percutaneous epiphysiodesis technique reliably arrests the growth as expected. Surgeons can confidently and accurately employ this technique to successfully treat leg length inequality.

Quantitative coronal plane motion of hindfoot during clinical flexibility assessments.

BACKGROUND: Common pediatric pathologic foot presentations include cavovarus and planovalgus feet. Flexibility of the hindfoot is established for these two clinical presentations through the Coleman block (eversion) and tiptoe tests (inversion). RESEARCH QUESTION: The purposes of this study are to establish typical quantitative eversion and inversion motion of the hindfoot during Coleman block and tiptoe tests using 3-D motion capture and demonstrate feasibility of using this data to assist in making treatment decisions. METHODS: Segmented foot model kinematics were collected for this prospective descriptive study with a focus on coronal plane inversion and eversion of the hindfoot relative to the tibia. Typical standing hindfoot position, with the feet plantigrade, was determined prior to performing the tiptoe test. Maximum hindfoot inversion was extracted from the tiptoe test. Maximum hindfoot eversion was extracted from the Coleman block tests. RESULTS: 32 typically developing subjects (age range 5-21 years) completed this study. Hindfoot motion data showed a mean standing foot position of 1 ° eversion, 10 degrees inversion during tiptoe test and 6 degrees eversion during the Coleman block test. SIGNIFICANCE: Establishing control values for hindfoot flexibility can assist with making clinical treatment decisions for disorders of the foot. At our center, clients who present to the Motion Analysis Center with foot concerns receive segmented foot model quantitative assessment of hindfoot flexibility with Coleman block and tiptoe tests as appropriate.